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STSD-124

Rev. 1 / 10-05-18

Department of Science and Technology


SCIENCE EDUCATION INSTITUTE

APPLICATION FOR
SHIFTING COURSE
TRANSFERRING SCHOOL

Name of Scholar: ___________________________________________________________________


Year of Award: _____________________ Scholarship Award: Merit RA 7687
Course: ___________________________________________________________________________
School: ___________________________________________________________________________
If shifting, New Course: ______________________________________________________________
If transferring, New School: ___________________________________________________________
Effective: First Second Semester AY ____________________________

Please attach the following requirements:

1. Letter of Request to Shift/Transfer


2. Certification of Admission in New Course/School
3. Certification of Accredited Subjects
4. Certification of Year Level in New Course/School
5. Certification of Grades in all Semesters Enrolled

________________________ Noted by:


Name/Signature of Applicant
________________________
________________________ Name/Signature of Parent
Date

To be accomplished by SEI

APPROVED/DISAPPROVED ___________________________ _______________________


Date

Effectivity of Shifting/Transfer First Second Semester AY __________________________


Until First Second Semester AY __________________________
Scholarship Period After Shifting/Transfer _________________ Years
Remaining Period of Scholarship _________________ Semesters
Release of Financial Assistance After Shifting/Transfer Effective
First Second Semester AY __________________________

Deadline of Submission of Amendatory Agreement _________________________________________

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